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This is the Best Practices guide.
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This is the Best Practices guide.
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The purpose of Illness Management and Recovery (IMR) is to inform people about their mental illness in order for them to make informed decisions about their recovery, and teaching them strategies to cope with symptoms of mental illness. IMR is taught over a number of sessions. This guide will cover strategies to effectively teach IMR, suggested structure for IMR sessions, and summarize the ten modules that guide IMR session content.
IMR is an evidence based practice that provides a step by step approach to provide knowledge on mental illness and substance abuse to support a person in setting meaningful goals, making informed decisions about treatment, gathering information and skills to generate mastery over the symptoms of his/her mental illness, and making progress towards his/her personal recovery. The four components of IMR are as follows:
IMR is based on the values of building hope, recognizing a person as an expert in his/her own experience of mental illness, emphasizing personal choice, establishing a collaborative partnership, and demonstrating respect. Building hope is important for a person to actively participate in his/her treatment and developing coping skills. Recognizing a person as an expert in his/her experience of mental illness increases awareness of what strategies work for a person, and how to effectively help a person make progress toward his/her goal(s). Emphasizing personal choice is the goal of IMR. Emphasize personal choice by providing skills and information to help a person make choices about their treatment. Establishing a collaborative partnership diminishes hierarchy in the practitioner - client relationship, and allows the practitioner and client to work side by side. Demonstrating respect increases collaboration and creates a common ground.
There are three strategies to use when teaching IMR: motivational strategies, educational strategies, and cognitive behavioral strategies. These strategies are core components of successful IMR.
Motivational strategies address the essential question of why a should learn about the skills and information taught in the IMR curriculum. If a person feels that learning specific information or skills is irrelevant, he/she will not be motivated to learn. Building motivation is crucial for teaching each module in the IMR curriculum. Each IMR module includes motivational strategies to increase motivation in learning about the module.
Motivational strategies assist a person to understand how information and skills learned from the IMR curriculum will help them achieve his/her personal recovery goals. Help a person become motivated by making connections between a person's personal recovery goals and the information and skills obtained in the IMR curriculum.
Educational strategies include interactive teaching, checking for understanding, breaking information down, and reviewing information. Interactive teaching makes learning more lively and interesting. Listen to a person's contribution, explain what information means, answer questions, and maintain a two way communication stream to make a person feel valued, and a lesson engaging. Frequently check for understanding and ask a person to summarize information. Be aware of the affects of mental illness on cognitive functioning. Present information in small parts with frequent pauses. Summarize inofrmation, make connections to previous material, and review handouts and homework to ensure a person understand the content of the lesson.
A person needs to be able to apply the information in the IMR curriculum to managing their mental illness and recovery. The numerous cognitive behavior strategies help people apply what they learn.
There are two types of reinforcement: Positive reinforcement and negative reinforcement. Positive reinforcement is an addition of something that is pleasant. This could be food, money, a hug, or praise. Negative reinforcement is a subtraction of something that is unpleasant. This includes decreasing the feeling of anxiety, anger, or boredom. Use reinforcements such as praise, smiles, interest, and enthusiasm in IMR sessions to encourage learning and promote a continued desire for change. If a person recognizes a correlation between reduced symptoms and relaxation methods, use this as a negative reinforcement to promote continued use of coping skills.
A shaping approach to teaching skills in the IMR program is helping a person break the learning process down into small manageable steps. Acknowledge each step, summarize progress, and offer praise. This will help maximizes a person's success in retaining information and skills.
Modeling is demonstrating skills for the purpose of teaching. Modeling can be used for a variety of skills. Model skills a person uses alone by narrating each step and explain what you are thinking. Model social skills by roleplaying these skills. Explain the skill before roleplaying.
Role playing gives a person the opportunity to practice and become more familiar with skills. The following is a format for roleplaying:
Maintain awareness of a person's comfort level with roleplaying. Try to find a setting or partner that will help a person feel more comfortable with roleplaying. Follow roleplaying with positive comments and constructive feedback. Roleplaying can be assigned for homework. Encourage a person to practice roleplaying with a supportive friend or family member. Continue to practice and assign roleplaying as homework until the skill is mastered.
The way a person views and thinks about him/herself and the world effects how he/she responds to events. Personal experience, mood, and what others have said influence a person's worldview. Cognitive restructuring helps a person find an adaptive, and sometimes more accurate, way of viewing the world. Provide basic information to a person, try to understand a person's views, and help a person develop adaptive perspectives in order to develop cognitive restructuring. This can be done informally or as a coping skill.
Behavior tailoring helps a person develop strategies in his/her daily life to incorporate taking medicine. Identify an activity in a person's daily routine that can incorporate taking medications. Building medication into a routine will give a person regular cues to take his/her medication. Cues can include brushing teeth. Model the routine with the person. This can be assigned as homework.
Help a person recognize early warning signs of relapse, and develop a plan to respond to those signs in order to prevent relapse. The following are steps from Substance Abuse and Mental Health Services Administration (SAMSHA) to develop a Relapse Prevention Plan:
Roleplaying the Relapse Prevention Plan helps a person become familiar with the plan. This can be assigned for homework. Roleplaying with supportive friend or family member increases the effectiveness of a Relapse Prevention Plan.
Coping skills help a person establish productive strategies for dealing with symptoms. Coping skills are based on cognitive behavior strategies while using motivational and educational strategies. SAMHSA provides the following steps used in coping skills training:
In the IMR program, practitioners and clients meet weekly for three to ten months. This can be done in an individual or in a group setting. Both settings are beneficial to a person. An individual setting allows the material to be paced according to a person's needs, and time can be devoted to specific concerns. A group setting increases the amount and variety of feedback, motivation, ideas, support, and role models a person can receive.
Each IMR session can be anywhere from 45 minutes to an hour. The length of the session depends on a person's engagement. Breaks may be beneficial, or more frequent 20 to 30 minute sessions.
The following is the suggested structure of each IMR session:
| Activity | Length |
| Informal socializing and identification of any major problems | 1 - 3 minutes |
| Review previous session | 1 - 3 minutes |
| Review homework | 3 - 5 minutes |
| Follow-up on goals | 1 - 3 minutes |
| Set agenda for current session | 1 - 2 minutes |
| Teach new material or review previously taught material | 30 - 40 minutes |
| Agree on new homework assignment | 3 - 5 minutes |
| Summarize progress made in current session | 3 - 5 minutes |
The IMR program is comprised of ten modules. Each of these modules can be paced flexibly.
Beginning with recovery strategies sets a positive tone for the IMR group. It sets the precedent that people can move forward with their lives. Encourage a person to develop his/her own definitions of recovery, and instill hope that it is reachable. Identify strategies that will help make progress towards recovery, goals, and steps to achieve his/her goals.
Providing a person with facts about mental illness empowers them to understand the basic facts about his/her disorder and advocate for himself/herself. Answer the following questions when discussing this module:
Present optimism for the future and assure that mental illness is no ones fault. Assist a person in recognizing examples of symptoms they experienced. Introduce the stress-vulnerability model. Acknowledge examples of people who have mental illness and lead productive lives.
This module explains causes of mental illness and what factors affect its course. The stress-vulnerability model examines several different treatment options for a person to manage his/her mental illness and reach recovery goals. Help a person decide which treatment option he/she wants.
Stress contributes to symptoms of mental illness. Social support helps people manage stress better and reduces relapses. Express the benefits of having supportive family members or friends involved in treatment plans. In this module, a person will assess his/her social support, where he/she may meet people to gain social support, and come up with strategies for increasing closeness in relationships. Assist a person in recognizing and practicing strategies for building relationships with people.
Discuss medication and how medication contributes to recovery. Facilitate an open discussion about positive and negative side effects of medications. This helps a person make informed decisions about his/her medication. Present strategies for behavior tailoring to help a person incorporate medication in a daily routine for those wanting to take medications.
Inform a person about the effects of drugs and alcohol on mental illness, and that decreasing substance use can help a person reach his/her recovery goals. Discuss the positive and negative effects of using substances in order for a person to make informed decisions. Help people who want to stop using substances create a three step plan. The three step plan includes identifying a reason why a person wants to stop using substances, identifying high risk situations, making a plan about how to deal with a high risk situation, and developing other ways for the person to get his/her needs met.
Examine a person's previous experience with relapse in order to develop a relapse prevention plan. Help a person identify relapse warning signs and steps to prevent relapses. Encourage a person to include family members and supportive people in a relapse prevention plan. Express confidence in preventing future relapses.
Coping with stress can decrease and limit relapses. In this module, aid a person to identify different types of stress and personal signs of being under stress. Practice different coping strategies during sessions to decrease symptoms and stress.
Help a person understand how to recognize problems, deal with problems, and cope effectively. There are two approaches to teaching a person how to deal with a problem. The first approach is using a step by step method to solve problems and achieve the desired goal. The second approach is using coping strategies for specific problems. A person can choose which approach works better for them. Practicing how to solve problems can be assigned as homework.
Discuss information about the mental health system, describe services offered by communities, and offer insight on community resources. This information will help a person make informed decisions about his/her personal path to recovery and to advocate for himself/herself.
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